Partial Year Career Furlough Notice

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					                                  UNIVERSITY OF CALIFORNIA, DAVIS
                                       NOTICE OF FURLOUGH

Instructions: This form should be provided to each partial-year career employee at least 30 calendar days prior
to a scheduled furlough, if possible. (Copy this form as needed.)

Employee Name: ___________________________ Employee ID: ______________________
This is to remind you that you are scheduled to be on furlough from:
        _____/_____/_____ through _____ /_____/_____.
Your return-to-work date is _____/_____/_____.
General information on benefits during furlough follows; you should contact the Campus or UCDHS Benefits
Office for additional information.

1. The University will continue its contribution to the cost of UC-paid group insurance plans (medical, dental,
   optical, UC-paid life, and UC-paid disability) for up to 3 full months provided that the employee pays any
   amounts that exceed the UC contribution. Supplemental life, dependent life, supplemental disability,
   accidental death and dismemberment, and legal insurance premiums may also be continued during the
   furlough. If the furlough is for one or more full calendar months, and there are required premium deductions
   from an employee’s pay, the Benefits Office will send a letter regarding the payment of insurance premiums
   to employee's home address, as indicated on the Payroll/Personnel System.

2. Employee contributions to any of the plans in the UC Retirement System and DepCare are discontinued
   while off pay status but are reinstated upon return. If you participate in the UC Tax-Deferred 403(b) Loan
   Program, you must make arrangements to continue your monthly payments by contacting the UC Benefit
   Programs Loan Office in Oakland at (800) 239-4002, extension 70747.

3. Participation in HCRA automatically ends when furlough begins. SHPS will send COBRA information if
   employee desires to continue participation. Employee may reenroll into HCRA within 31 days upon return
   to pay status at prior annual rate. Please note that if reenrollment occurs and COBRA was not elected, then
   monthly contribution rate will increase. Contact your Benefits Office for more information.

4. If you have insurance policies through California Casualty you must pay your insurance premiums directly
   to the carrier during furlough.

5. You should cancel your parking permit at the Transportation and Parking Services Office and arrange with
   your credit union to make any loan payments directly to them during your furlough. Cancellation of payroll
   deductions must be made by _____/_____ /_____ in order to meet payroll deadlines.

6. Time on furlough is not qualifying time for vacation or sick leave accrual, holiday pay, or service
   computation for seniority or service awards.

7. One full year of retirement service credit will be awarded if you are appointed and work 100% time for the
   prescribed term of the partial-year appointment (9, 10, or 11 months). For periods less than full-time,
   retirement service credit will be prorated. For more information, contact Benefits Office.

__________________________________                       ______________________________
Supervisor’s signature/ Date                             Supervisor’s Name (Print) Phone

Copies to:      Employee
                Payroll Division
                Department Personnel File
                Campus Personnel File
                Benefits Office
                                                                                                         Rev 10/10

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